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Cruciate-Retaining Versus Cruciate-Substituting Total Knee Arthroplasty: A Meta-Analysis

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Abstract

Background

Primary total knee arthroplasty (TKA) can be performed using cruciate-retaining (CR), cruciate-substituting (CS), or posterior-stabilized (PS) total knee arthroplasty designs. While there have been many studies comparing the outcomes of CR versus PS TKA, the current literature is lacking in systematic reviews and meta-analyses that compare outcomes of CR knees versus CS TKAs.

Methods

This study is a systematic review and meta-analysis of the literature comparing CR and CS knees with regard to survivorship, functional, and patient-reported outcomes, range of motion (ROM), biomechanics, and revision rate. PubMed, Cochrane, and Embase were used for the literature search, and the Modified Coleman Methodology Score was used to assess the quality of the studies.

Results

Seven studies met the inclusion criteria. This systematic review and meta-analysis suggests that there are no significant differences in survivorship, ROM, or clinical knee scores between the CR and CS knees. Postoperative complications did not vary greatly between the CR and CS groups. Among the seven studies, three CR designs needed revision for either patellar crepitus, joint stiffness, or aseptic loosening of the tibial component. One CS design needed arthrotomy due to patellar clunk syndrome.

Conclusion

CR and CS knees are both reasonable options for primary TKA.

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Data availability

The data that support the findings of this meta-analysis are publicly available in the included studies and their respective publications. All relevant references have been provided in the reference list. No additional data were generated or analyzed during the current study. For further inquiries regarding specific datasets used in this systematic review, readers are encouraged to refer to the original sources cited in the references. Access to these datasets may be subject to the policies and permissions set by the respective authors or organizations. Researchers interested in reproducing or validating the findings of this systematic review are advised to consult the primary sources directly.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Ryan C. LeDuc and Drashti Upadhyay are the co-first authors to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S First Ave. Maguire Bldg. Ste 1300, Maywood, IL, 60153, USA

    Ryan C. LeDuc & Nicholas M. Brown

  2. Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA

    Drashti Upadhyay

Authors
  1. Ryan C. LeDuc
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Correspondence to Ryan C. LeDuc.

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Conflict of Interest

The authors of this manuscript have no conflicts of interest to disclose. Dr. Brown is a paid consultant for Depuy/Synthes and Corin USA, and board or committee member of American Academy of Orthopaedic Surgeons. All other authors have no competing interests to declare. There were no sources of funding for this review.

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LeDuc, R.C., Upadhyay, D. & Brown, N.M. Cruciate-Retaining Versus Cruciate-Substituting Total Knee Arthroplasty: A Meta-Analysis. JOIO 57, 1188–1195 (2023). https://doi.org/10.1007/s43465-023-00914-6

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